一位出血型中風病人面臨生命自決困境之護理經驗

The Nursing Experience of a Hemorrhagic Stroke Patient Facing Dilemma in Self-determination of Living

10.6540/NTJN.202303_25(1).0012

黃俐禎(Li-Chen Huang)；李春蘭(Chun-Lan Lee)

出血性腦中風 ； 生命自決 ； 預立醫療決定 ； hemorrhagic stroke ； self-determination ； advance decision

新臺北護理期刊

25卷1期（2023 / 03 / 01）

128 - 137

繁體中文;英文

本文描述一位出血型中風病人面臨生命自決困境之護理經驗，照顧期間自2020年7月9日至8月7日，筆者透過直接照護、會談、觀察及病歷檢閱等方式，運用Gordon十一項健康功能型態進行整體性評估。住院期間隨著病情變化進展至生命末期，在家屬與病人意見相左的情況下，病人除有氣體交換障礙之健康問題外，還出現對於追求生命善終的無力感，而家屬則面臨病人死亡威脅的哀傷等健康問題。護理過程中，除了提供個別性護理外，秉持尊重病人自主權為生命末期照護之核心價值，並以病人為中心進行治療目標的溝通，透過家庭與個別會談的方式，引導病人與家屬進行對話，陳述內心的想法與感受；同時向家屬解說預立醫療決定之內涵，撫慰家屬的內疚與不捨。最終，病人獲得善終，家屬達成善別，生死兩無憾。期望藉此護理經驗，提供醫療人員照護相關個案之參考。未來，建議加強宣導病人自主權利法的核心概念及教育訓練，進行臨床經驗分享，並且透過情境模擬溝通課程，提升協助家庭面對生命末期決策困境及照護能力。

This article is talking about the nursing experience of a hemorrhagic stroke patient facing dilemma in self-determination of living. The period was from July 9th, 2020 to August 7th, 2020. The author did a holistic assessment with direct nursing, conversation, observation, reviewing medical records, and Gordon 11 Function Health Patterns. During hospitalization, it became a terminal illness. With the disagreement between patient and the family, the patient had gaseous exchange issue and felt powerless about pursuing a good death. While the family suffered from the coming death of the patient, during the nursing, besides providing individual caring, showing respect to patient's autonomy was the core value of terminal illness nursing, such as having conversation about treatment target with patient and family, guiding the patient to communicate with the family, describing their thoughts and feeling to each other, and explaining the connotation of Advance Decision to the family in order to smoothen their grief. In the end, the patient had good death. The family said goodbye with no regret. It is expected by providing this case, those who are health care workers could have a reference. In the future, we could disseminate the core connotation about Patient Right to Autonomy and have the training with experience sharing and scenario simulation to improve nursing with professionalism to help families to face the determination of living dilemma.

1. 陳姵如,王桂芸(2018)。慢性阻塞性肺部疾病患者肺部復健之臨床應用及成效。源遠護理，12(1)，5-10。
   連結：
2. 陳詩佩,曾斐琳,黃琨祥,施君穎,周嫚君,江明珠(2019)。尊重生命的選擇～淺淡病人自主權利法。長庚護理，30(4)，466-473。
   連結：
3. 黃詩凌,賴維淑,方素瓔(2018)。運用風扇緩解呼吸困難－系統性文獻回顧與臨床應用。護理雜誌，65(4)，84-93。
   連結：
4. 楊婉萍,劉芊葳,宋聖芬(2018)。在死亡與苦難前相濡以沫－癌末病人家屬的靈性照護。護理雜誌，65(3)，22-27。
   連結：
5. 病人自主權利法（2019，6月12日）‧總統華總一義字第10800059281號令修正。https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020189
6. 全民健康保險安寧共同照護試辦方案（2015）‧https://www.nhi.gov.tw/Resource/bulletin/5814_1040007177-1.pdf
7. Albert, R. H.(2017).End-of-life care: Managing common symptoms.American Family Physician,95(6),356-361.
8. Cardona-Morrell, M.,Kim, J.,Turner, R. M.,Anstey, M.,Mitchell, I. A.,Hillman, K.(2016).Non-beneficial treatments in hospital at the end of life: A systematic review on extent of the problem.International Journal for Quality in Health Care,28(4),456-469.
9. Centers for Disease Control and Prevention.(2021).Types of Stroke. https://www.cdc.gov/stroke/types_of_stroke.htm
10. General Medical Council(2010).Treatment and care towards the end of life: Good practice in decision making.
11. HammondCare.(2014).Assessment tools:palliative care bridge.https://f.hubspotusercontent00.net/hubfs/8316206/Pallative_Care_Bridge_July2021/Pdf/AssessmentTools_Book_Final.pdf
12. Kreher, M.(2016).Symptom control at the end of life.Medical Clinics of North America,100(5),1111-1122.
13. Nsiah, C.,Siakwa, M.,Ninnoni, J. P. K.(2019).Registered nurses' description of patient advocacy in the clinical setting.Nursing Open,6(3),1124-1132.
14. Richards, N.,Ingleton, C.,Gardiner, C.,Gott, M.(2013).Awareness contexts revisited: Indeterminacy in initiating discussions at the end-of-life.Journal of Advanced Nursing,69(12),2654-2664.
15. 林譽家,林明慧,陳曾基(2021)。末期病人預後評估與預後量表的臨床應用。家庭醫學與基層醫療，36(8)，256-263。
16. 孫文榮,璩大成,黃勝堅(2015)。『我的家人好像快不行了，我該怎麼辦？』－淺談瀕死期照護。北市醫學雜誌，12(4)，419-423。
17. 蔡甫昌,郭蕙心(2017)。病人自主權利法之倫理觀點與實務挑戰。台灣醫學，21(1)，62-72。
18. 蔡憶雲(2019)。銀髮族整體輔助芳香療法之應用。長庚科技學刊，31，21-28。